Ian Cleary

Getting better or just getting better at managing?

March 11, 2016IanChronic Fatigue Syndrome & ME, Chronic Pain/ Fibromyalgia, Depression, anxiety and other conditions, Lightning Process, NeuroplasticityComments Off on Getting better or just getting better at managing?

The understanding of NEUROPLASTICITY has become a valuable tool in working with both physical and mental health.

NEUROPLASTICITY is the process where the brain alters its structure and function as an adaptation to experience. The implications of this are huge. One implication is that the things that people do to ‘manage’ their problem are also ‘experiences’ so the brain changes and adapts to management techniques.

Another way to think about it, is that the brain of someone managing their illness well is very different from someone who is actually well.

Many people think that they can ‘manage’ their way to full health. But they are different processes.

A really great example of this is described in Norman Doidge’s book, The Brain That Changes Itself. Stroke rehabilitation specialist, Dr Taub realised that when someone lost movement of one arm, they naturally compensated and learnt how to function with the working arm. This however created changes in the brain. The parts in the brain involved in moving the stroke effected arm were not being used so disappeared as the brain’s neurology works on a ‘use it or lose it policy’. Meanwhile the parts of the brain associated with the still working arm increased in area. The person was in essence ‘managing’ their stroke by becoming really good at being a one armed person and the brain changed as a result of this.

This is the Neurobiology of Compensation.

Dr Taub therefore developed a novel stroke rehab technique called ‘Constraint induced therapy’.  When someone loses the use of one arm, using their working arm makes sense but this has nothing to do with full recovery and can get in the way of full recovery. You are just getting good at becoming a one armed person. So ‘Constraint induced therapy’ for strokes now involves tying down the working arm. Any compensation activity (or management technique) changes the brain away from the where you want to be. Tying down the working arm forces people to focus on the aim of retrain the stroke affected arm.

This technique is based on our understanding that we can retrain the brain – even if there is damage. (Read Brain that Changes itself)

What we do to ‘get by’ might get in the way of ‘getting better’ – The broader context

Think of someone with agoraphobia (fear of panic attacks). You can manage that well by staying inside the house.  Great. Problem solved? No. Just well managed. This management technique is an experience that changes the wiring of your brain. Some areas that are not being used weaken (socializing, spacial awareness of the city, procedural memory of public transport, reduction of stress because you are ‘safe’). You get good at staying inside but you haven’t beaten the anxiety just managed it well. With good management comes changes in the body and the brain but you are stuck inside.

So is the answer just going outside and pushing through the discomfort? Interesting – forcing yourself to go outside while you feel terrible also is an experience that changes your brain. The parts of your brain associated with detecting danger and threats get well developed, body awareness of sensations like a racing heart develops and the brain associates certain places with horrible feeling and stress hormones. The brains links outside with fear. Just pushing through doesn’t do it. So people often move back into the more bearable management technique of avoidance. You are not getting better just better at managing it.

Avoidance or pushing through are not about getting better and over time these techniques change the brain. Paradoxically good management can become an obstacle to full health. People often assume the only two options with Chronic pain and fatigue conditions are also to either “push through” and pay for it or avoid the things that set them off. But if you think of the agoraphobia example, neither of these techniques are addressing the issue and are experiences that alter brain structure and function.

When people come to me they tend to have developed a mixture of techniques between pushing through and avoiding what sets them off.

The Lightning Process is suggesting an alternative option – to actively retrain your brain and body to respond more appropriately.

You do have to be committed and focused but the brain and body are highly adaptable. The brain will adapt and get good at whatever you are doing.

So the question is  – Are you getting good at managing the problem or are you actually solving it?

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